radiation for positive margins

got my first dose of radiation to day for the positive margin
i will be getting 33 sessions - 66 Grays

Age 61 at DX
Biopsy 7/2008 Positive 1 of 12 cores positive 3+4 5% To 10%
Open Radical Prostatectomy 15/10/2008

Stage pt2c
Post op staging Gleason's Score 3+4=7
apical margin is focally positive
no extraprostatic extension
Seminal vesicles and lymph nodes clear
Catheter out on the 13/11/2008

4 week PSA < 0.1

26/1/2009 < 0.1

20/4/2009 < 0.1

20/7/2009 < 0.1

Tony Crispino

Veteran Member

Joined : Dec 2006

Posts : 8129

Posted 8/26/2009 10:13 AM (GMT -7)

Hi 6071,
I am interested in more of your story. It's been 6 months and you have had a clean slate with the PSA's. I am a proponant of adjuvant radiation in cases like yours but there are some differences of what we call standard here in the States. 33 treatments of which kind of radiation ~ EBRT or IMRT? Is this standard protocol in Ireland?

Tony

Age 47 (44 when Dx)

Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007

Gleason 4+3=7, Stage pT3b, N0, Mx

Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)

HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)

IMRT radiation for 38 Treatments ending August 3, '07

Current PSA (May 11, 2009): <0.1

My Journal is at Tony's Blog

My InfoLink page is at Tony's Prostate Cancer InfoLink Page

STAY POSITIVE!

Purgatory

Elite Member

Joined : Oct 2008

Posts : 25440

Posted 8/26/2009 10:55 AM (GMT -7)

With all your post surgery psa's of zero, why now? what made the difference to go ahead and start treatments?

david in sc

Age 57, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5

3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3

Open RP surgery 11/14/8, Right nerves spared, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9

Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsule, one post. margin, clear lymph nodes

2009 PSA 2/9 .05, 5/9 .10, 6/9 .11, 8/9 .16

Lastest 7/13 met with Rad. Oncl, considering options, 7/20 Catheter #6 after complete blockage, 8/14 met with Rad Oncl, 8/18 - laser scope surgery to clear blockage, now on Cath #7, 8/26 - cath removed

6071

Regular Member

Joined : Jul 2008

Posts : 114

Posted 8/26/2009 1:54 PM (GMT -7)

TC-LasVegas

i think i am getting IMRT radiation will ask tomorrow

Purgatory
when i had rp surgery my surgeon said i was to get it.
over hear we have a waiting list so it could be long wait if i have a rise in psa
we are not as fast over hear with treatment as you are in the usa
if you have the cash it is fast
surgery is done in 1 hospital radiation in an another hospital
had a ct scan in june and a ultra sensitive psa test i still did not get the psa results i will get it next week sometime
did not meet one doctor to day just the radiation team
and i had to drink loads of water before the radiation treatment plus i have to drink 2 liters a day
thanks

Age 61 at DX
Biopsy 7/2008 Positive 1 of 12 cores positive 3+4 5% To 10%
Open Radical Prostatectomy 15/10/2008

Stage pt2c
Post op staging Gleason's Score 3+4=7
apical margin is focally positive
no extraprostatic extension
Seminal vesicles and lymph nodes clear
Catheter out on the 13/11/2008

4 week PSA < 0.1

26/1/2009 < 0.1

20/4/2009 < 0.1

20/7/2009 < 0.1

Purgatory

Elite Member

Joined : Oct 2008

Posts : 25440

Posted 8/26/2009 3:00 PM (GMT -7)

6071, that makes perfect sense, didnt mean to sound crititcal, wasn't my intent.

surgery is one place here: hospital, and radiation is in another: radiation treatment center

david in sc

Age 57, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5

3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3

Open RP surgery 11/14/8, Right nerves spared, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9

Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsule, one post. margin, clear lymph nodes

2009 PSA 2/9 .05, 5/9 .10, 6/9 .11, 8/9 .16

goodlife

Veteran Member

Joined : May 2009

Posts : 2692

Posted 8/26/2009 3:08 PM (GMT -7)

I may be on the same track in terms of time. If my PSA's stay at zero, I am not planning on adjuvant radiation until my incontinence and ED are stabilized (hopefully). Even then I am not sure if I will do it until my PSA starts to rise.

Statiscally it doesn't appear to be a lot of difference between adjuvant and salvage, if salvage is begun early enough, and from a morbidity viewpoint, there is little difference.

Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9

Da Vinci, Cleveland Clinic 4/14/09 Nerves spared

0/23 lymph nodes involved pT3a NO MX

Catheter and 2 stints in ureters for 2 weeks due to anatomical issues with location of ureters with respect to bladder neck. Try 3 tubes where no tubes are supposed to be for 2 weeks !

Neg Margins, bladder neck negative

Living the Good Life, cancer free 6 week PSA <.03

3 month PSA <.01 (different lab)

Geebra

Regular Member

Joined : May 2009

Posts : 476

Posted 8/26/2009 8:23 PM (GMT -7)

I am two treatments in. I am getting 40 treatments for a total of 72 Grays to prostate bed and 45 Grays to pelvis. Plus HT. Mine is salvage, not adjuvant, but as Goodlife said, there is not a lot of difference, statistically speaking. I was hoping I would not need it... Father died from poorly differentiated PCa @ 78 - normal PSA and DRE 5 biopsies over 4 years negative while PSA going from 3.8 to 28 Dx Nov 2007, age 46, PSA 29, Gleason 4+4=8 Decided to participate in clinical trial at Duke - 6 rounds of chemo (Taxotere+Avastin) PSA prior to treatment on 1/8/2008 is 33.90, bounced on 1/31/2008 to 38.20, and down at the end of the treatment ( 4/24/2008) to 20.60 RRP at Duke (Dr. Moul) on 6/16/2008, Gleason downgraded 4+3=7, T3a N0MX, focal extraprostatic extension, two small positive margins PSA undetectable for 8 months, then 2/6/2009 - 0.10, 4 /26/2009 - 0.17, 5/22/2009 - 0.20, 6/11/2009 - 0.27 Salvage IMRT + 6 Months ADT: Casodex started 6/12/2009 , Lupron 6/22/2009, PSA 6/25/2009-0.1, T=516, 7/23/2009-<0.05, T<10, IMRT to start mid-Aug

zampilot

Regular Member

Joined : Aug 2009

Posts : 152

Posted 8/28/2009 5:10 AM (GMT -7)

6071, our history is quite similar but I'm 53. I'm getting my 12th rad today, 1/3 done with it. I had one margin, called a 'close' by one Doc, a 'positive' by another. It was "into the orange peel but not out of it" (meaning the prostate). My Rad Oncologist cited a european study, long term, which found a 40% chance of recurrence vs < 5% with radiation if any of the following were found in the surgery path report or first post surgery PSA test: involvment of the seminal vesicles, lymph nodes, high PSA or ....a positive margin.
I'm taking the rad even though there's not much chance one cell escaped the scalpel, but if one cell did escape, that's it, no cure.

Post Edited (zampilot) : 8/28/2009 6:34:16 AM (GMT-6)

6071

Regular Member

Joined : Jul 2008

Posts : 114

Posted 8/28/2009 12:57 PM (GMT -7)

thanks

zampilot

Age 61 at DX
Biopsy 7/2008 Positive 1 of 12 cores positive 3+4 5% To 10%
Open Radical Prostatectomy 15/10/2008

Stage pt2c
Post op staging Gleason's Score 3+4=7
apical margin is focally positive
no extraprostatic extension
Seminal vesicles and lymph nodes clear
Catheter out on the 13/11/2008

4 week PSA < 0.1

26/1/2009 < 0.1

20/4/2009 < 0.1

11/6/2009 ultra sensitive psa 0.07

20/7/2009 < 0.1

26/8/09 Starting IMRT

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